Applicability of portable retinal cameras and telemedicine as facilitating tools in screening diabetic retinopathy in the COVID-19 pandemic scenario / Aplicabilidade do retinógrafo portátil e telemedicina como ferramentas facilitadoras na triagem de retinopatia diabética no cenário de pandemia de COVID-19

ABSTRACT Purpose: Diabetes mellitus is a leading cause of impaired vision. The objective of this study was to evaluate the feasibility of use of portable retinograph and remote analysis of images along with a virtual questionnaire for screening for diabetic retinopathy in basic health units in the city of Ribeirão Preto/SP during the Covid-19 pandemic. Methods: Standard Covid-19 protocol was followed during the screening. Blood pressure and capillary blood glucose were measured. Demographic and social data were collected through a standardized online questionnaire via smartphone. After pupillary dilation, fundal images were obtained with portable retinographs by trained ophthalmology residents. Two standardized 45° images were acquired: one posterior segment and another nasal to the optic nerve. Diabetic retinopathy was classified according to the Early Treatment Diabetic Retinopathy Study. Results: A total of 350 patients (64% female; 45% aged 55-70 years; 55% Caucasian) were evaluated. For 40.5% of patients, the campaign was the first opportunity for retinal evaluation; 47.56% had diabetes mellitus for >10 years. On repeat analysis of images stored in a cloud-based repository by retinal specialist, a 7.8% difference was observed in the Early Treatment Diabetic Retinopathy Study diabetic retinopathy classification, compared to the screening findings. Mild diabetic retinopathy was observed in 12.23%, moderate diabetic retinopathy in 6.31%, and proliferative diabetic retinopathy in 2.58% patients. Macular edema was present in 4.58% patients. Diabetic retinopathy was not detected in 72.78% patients. Conclusion: Use of portable retinographs together with telemedicine can provide efficient alternative to traditional methods for screening and diagnosis of diabetic retinopathy.

RESUMO Objetivo: A diabetes mellitus é considerada uma epidemia global e causa de baixa visual em países em desenvolvimento. Este estudo foi realizado com o objetivo de avaliar a viabilidade do retinógrafo portátil e análise remota de imagens associada a questionário virtual para o rastreio de retinopatia diabética em Unidades Básicas de Saúde da cidade de Ribeirão Preto/SP durante a pandemia de Covid-19. Métodos: Trezentos e sessenta pacientes compareceram a campanha. O acolhimento foi realizado na Unidade Básica de Saúde pela equipe de enfermagem, respeitando medidas de prevenção do Covid-19 Os realizou-se aferição da pressão arterial e glicemia capilar seguida de dilatação. Dados demográficos e sociais foram coletados através de questionário on-line padronizado via smartphone e realizou-se a triagem da retinopatia diabética através da obtenção de imagens com retinógrafos portáteis realizados por residentes de oftalmologia previamente treinados, com a aquisição de 2 imagens padronizadas de 45º: uma do segmento posterior e outra nasal ao nervo óptico. Resultados: Trezentos e sessenta pacientes foram atendidos durante a campanha. Dez pacientes (1,02%) foram excluídos devido à opacidade de meios e impossibilidade de obtenção de imagens de fundo de olho. Foram avaliados 350 pacientes, 64% do sexo feminino, 45% entre 55 e 70 anos e 55% brancos. A Campanha foi a primeira avaliação de retina para 40,5% dos pacientes e 47,56% apresentavam diabetes mellitus há mais de 10 anos. Na análise comparativa da classificação da retinopatia diabética segundo Early Treatment Diabetic Retinopathy Study (triagem X Nuvem) observou-se uma diferença de 7,8% nos resultados. Retinopatia diabética leve foi observada em 12,23%, moderada em 6,31%, proliferativa em 2,58%; edema macular presente em 4,58% e ausência de retinopatia diabética em 72,78% dos pacientes. Conclusão: A utilização de retinógrafos portáteis juntamente a telemedicina, para o rastreamento da retinopatia diabética pode ser considerada uma alternativa eficiente para triagem e diagnóstico da retinopatia diabética dentro ou fora do cenário pandêmico, auxiliando na prevenção de perda visual pelo diabetes.

Use of bedside echocardiography in the care of critically ill patients - a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência, and Sociedade Brasileira de Medicina Hospitalar. Part 1 - Competence in bedside echocardiography / Uso da ecocardiografia à beira do leito no cuidado do paciente grave - um documento conjunto de consenso da Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência e Sociedade Brasileira de Medicina Hospitalar. Parte 1 - Competência em ecocardiografia à beira do leito

ABSTRACT The use of echocardiography by physicians who are not echocardiographers has become common throughout the world across highly diverse settings where the care of acutely ill patients is provided. Echocardiographic evaluation performed in a point-of-care manner can provide relevant information regarding the mechanism of causes of shock, for example, increasing the rates of correct diagnosis and allowing for faster informed decision-making than through evaluation methods. Considering that the accurate diagnosis of life-threatening situations is essential for professionals working with acutely ill patients, several international associations recommend that physicians responsible for critically ill patients acquire and develop the ability to perform bedside ultrasound examinations, including echocardiographic examinations. However, there is no consensus in the literature regarding which specific applications should be included in the list of skills for nonechocardiographer physicians. Taking into account the multiplicity of applications of echocardiography in different scenarios related to acutely ill patients; the differences in the published protocols, with regard to both the teaching methodology and competence verification; and the heterogeneity of training among highly diverse specialties responsible for their care at different levels, this consensus document aimed to reflect the position of representatives of related Brazilian medical societies on the subject and may thus serve as a starting point both for standardization among different specialties and for the transmission of knowledge and verification of the corresponding competencies.

RESUMO O emprego da ecocardiografia por médicos não ecocardiografistas tem se tornado comum em todo o mundo nos mais diversos ambientes em que se dá o cuidado do paciente agudamente doente. A avaliação ecocardiográfica realizada de forma point-of-care pode fornecer informações pertinentes em relação ao mecanismo das causas de choque, por exemplo, incrementando as taxas de diagnóstico correto e possibilitando a tomada de decisão fundamentada de forma mais rápida do que por meio dos métodos tradicionais de avaliação. Considerando que o diagnóstico preciso de situações ameaçadoras à vida é indispensável a profissionais atuando junto a pacientes agudamente enfermos, diversas entidades associativas internacionais recomendam que médicos responsáveis por pacientes gravemente doentes devam adquirir e desenvolver a habilidade para realizar exames ultrassonográficos à beira do leito, inclusive ecocardiográficos. Entretanto, não há consenso na literatura acerca de quais aplicações específicas devam compor o rol de habilidades do médico não ecocardiografista. Levando-se em consideração a multiplicidade de aplicações da ecocardiografia em diversos cenários relativos ao paciente agudamente enfermo; as diferenças nos protocolos publicados, tanto no que diz respeito à metodologia de ensino como de verificação de competências, bem como a heterogeneidade da formação entre as mais diversas especialidades responsáveis pelo seu cuidado em diferentes níveis, este documento de consenso teve o objetivo de refletir o posicionamento de representantes de sociedades médicas brasileiras afins acerca do tema, podendo, assim, servir de ponto de partida para a uniformização entre diferentes especialidades, bem como para a transmissão de conhecimento e a verificação das competências correspondentes.

Validity of point-of-care device for diagnosing anemia in workers exposed to lead

Detecting anemia in occupational health settings is critical in a high-risk population for anemia like the lead-exposed. Whether the point-of-care devices are sensitive to detect anemia in individuals with high levels of lead exposure is unknown. We compared hemoglobin (Hb) levels from HemoCue® Hb 301 System and standard analyzer, Mindrey-BC 5300, in individuals (n=58) exposed to lead (mean levels = 44.9 ?g/dL) for a chronic period (mean duration of exposure = 105 months). We observed high sensitivity (0.95), specificity(0.95) in detecting anemia by hemocue, and high agreement between the methods. The significant difference in Hb values between the methods (0.171g/dL, p=0.018) was clinically minimal. We conclude that hemocue is a good method for rapidly detecting anemia and estimating Hb levels among the lead-exposed in resource-limited settings.

Telemedicine can be a feasible means of guiding untrained general practitioners to perform point-of-care ultrasound in life-threatening situations: the case of a field hospital during the COVID-19 pandemic / O ultrassom guiado por telemedicina realizado por clínicos gerais não treinados pode ser viável em uma situação de risco de vida: o caso de um hospital de campanha durante a pandemia de COVID-19

Abstract Objective: To evaluate the feasibility of telemedicine using a standardized multiorgan ultrasound assessment protocol to guide untrained on-site general practitioners at a field hospital during a life-threatening crisis. Materials and Methods: We evaluated 11 inpatients with shock, with or without acute dyspnea, for whom general practitioners spontaneously requested remote evaluation by a specialist. Results: All of the general practitioners accepted the protocol and were able to position the transducer correctly, thus obtaining key images of the internal jugular vein, lungs, and inferior vena cava when guided remotely by a telemedicine physician, who interpreted all of the findings. However, only four (36%) of the on-site general practitioners obtained the appropriate key image of the heart in the left parasternal long-axis view, and only three (27%) received an immediate interpretation of an image from the remote physician. The mean evaluation time was 22.7 ± 12 min (range, 7-42 min). Conclusion: Even in life-threatening situations, untrained general practitioners may be correctly guided by telemedicine specialists to perform multiorgan point-of-care ultrasound in order to improve bedside diagnostic evaluation.

Resumo Objetivo: Avaliar a viabilidade da orientação por telemedicina de médicos in situ não treinados na avaliação ultrassonográfica de múltiplos órgãos mediante protocolo padronizado, durante uma situação de risco de vida em hospital de campanha. Materiais e Métodos: Avaliamos 11 pacientes com choque e/ou dispneia de manifestação aguda durante a internação, cujos clínicos gerais solicitaram auxílio de especialista a distância. Resultados: Todos os médicos aceitaram o protocolo e, posicionando o transdutor, obtiveram imagens-chave da veia jugular interna, pulmão e veia cava inferior, quando guiados por um médico via telemedicina, que interpretou os achados desses órgãos. No entanto, apenas quatro (36%) médicos in situ obtiveram a imagem-chave apropriada do coração na janela paraesternal do eixo longo esquerdo e três (27%) tiveram imagem remotamente interpretada imediatamente. O tempo de avaliação variou de 7-42 minutos (média de 22,7 ± 12 minutos). Conclusão: Em situação de risco de vida, os clínicos gerais não treinados podem ser corretamente orientados por especialistas em telemedicina para realizar ultrassonografia multiórgãos in situ, melhorando o diagnóstico beira do leito.

Current status and research progress of POCT-based detection technology for 2019-nCoV / 中华检验医学杂志

In view of the significant changes in the prevention and control of COVID-19 at home and abroad, "external prevention of importation and internal prevention of rebound" has become the focus of prevention and control of the epidemic in China. Due to the limitation of testing sites, equipment and reaction time, traditional detection methods cannot meet the needs of real-time and rapid detection of 2019-nCoV. Point-of-care testing (POCT) is rapid, portable and flexible. It plays an increasingly important role in the rapid detection and screening of 2019-nCoV. Here, we review the current status and research progress of POCT for 2019-nCoV in terms of antigens, specific antibodies and nucleic acids, in order to provide reference for epidemic prevention and control and clinical management.

Use of bedside ultrasound in the evaluation of acute dyspnea: a comprehensive review of evidence on diagnostic usefulness / Uso de ecografía a pie de cama en la evaluación de la disnea aguda: una revisión exhaustiva de la evidencia sobre su utilidad diagnóstica / Uso de ultrassom à beira do leito na avaliação da dispneia aguda: uma revisão abran-gente das evidencias sobre sua utilidade diagnostica

Introduction: Acute dyspnea is one of the most frequently observed symptoms in emergency departments, which can be caused mainly by pulmonary or cardiac system involvement. Bedside ultrasound is postulated as an inno-vative tool for basic use by the physician, which can complement the physical examination and quickly explore the integrity of thoracic structures. Objectives: To synthesize recent evidence on the use of bedside ultrasound in the evaluation of acute dyspnea. Materials and methods: A bibliographic search was carried out using search terms such as "Bedside Ultrasound" and "Acute Dyspnea," as well as synonyms, which were combined with Boolean operators, in the databases PubMed, ScienceDirect, Embase, EBSCO, and MEDLINE. Results: During the literature review, 10 observational studies, 2 clinical trials and 2 systematic reviews met the inclusion criteria and were ana-lyzed. The use of bedside ultrasound changes the main diagnosis associated with acute dyspnea in more than 60% of cases, the most frequent being acute decompensated heart failure and pneumonia. Protocols such as SEARCH 8Es for the evaluation of dyspnea in the emergency department, has a performance with sensitivity, specificity, positive and negative predictive value parameters above 95%. Conclusions: The current evidence on the use of bedside ultrasound in the management of patients with acute dyspnea in the emergency department is limited, Although the level of evidence is not the best, it suggests that this tool may promote the diagnostic perfomance of acute dyspnea of pulmonary or cardiac causes, improve the time to diagnosis, and enhance physician diagno-stic confidence.

Introducción: La disnea aguda es uno de los síntomas más observados en los servicios de urgencias, que puede estar causada por la afectación del sistema pulmonar o cardiaco. La ecografía a pie de cama se postula como una herramienta innovadora, al complementar la exploración física con la eva-luación rápida de las estructuras intratorácicas. Objetivo: Sintetizar la evidencia reciente sobre el uso de la ecografía a pie de cama en la evaluación de la disnea aguda. Materiales y métodos: Búsqueda bibliográfica utilizando términos de búsqueda como Bedside Ultra-sound y Acute Dyspnea, así como sinónimos, que se combinaron con operadores booleanos, en cinco bases de datos. Resultados: Se evidenció que el uso de la ecografía a pie de cama cambia el diagnóstico principal asociado con la disnea aguda en más del 60 % de los casos, entre los cuales los más frecuentes fueron la insuficiencia cardiaca aguda descompensada y la neumonía. Protocolos como el SEARCH 8Es para la evaluación de la disnea en el servicio de urgencias tiene un rendimiento con parámetros de sensibi-lidad, especificidad, valor predictivo positivo y negativo superiores al 95 %. Conclusión: La evidencia actual sobre el uso de la ecografía a pie de cama en el tratamiento de los pacientes con disnea aguda en el servicio de urgencias es limitada. No obstante, sugiere que esta herramienta puede favorecer el rendimiento diagnóstico de la disnea aguda de causa pulmonar o cardiaca, mejorar el tiempo de diagnóstico y aumentar la confianza del médico en el diagnóstico

Introdução: A dispneia aguda é um dos sintomas mais observados no departamento de emergência, que pode ser causado pela afetação do sistema pulmonar o cardíaco. O ultrassom à beira do leito é proposto como uma ferramenta inovadora, complementando o exame físico com uma rápida ava-liação das estruturas intratorácicas. Objetivo: sintetizar evidências recentes sobre o uso do ultrassom à beira do leito na avaliação da dispneia aguda. Materiais e métodos: Pesquisa de literatura usando termos de busca tais como Bedside Ultrasound e Acute Dyspnea, bem como sinônimos, que foram combinados com operadores booleanos, em cinco bancos de dados. Resultados: O uso do ultrassom á beira do leito mostrou a mudança do principal diagnóstico associa-do com a dispneia aguda em mais de 60% dos casos, sendo o mais frequente a insuficiência cardíaca descompensada aguda e a pneumonia. Protocolos como o SEARCH 8Es para a avaliação da dispneia no serviço de emergência tem um desempenho com parâmetros de sensibilidade, especificidade, valor preditivo positivo e negativo superiores ao 95%. Conclusão: As evidencias atuais sobre o uso do ultrassom á beira do leito no gerenciamento de pa-cientes com dispneia aguda no serviço de emergências são limitadas. No entanto, sugere que esta ferramenta pode favorecer o rendimento diagnóstico da dispneia aguda de causa pulmonar ou car-díaca, melhorar o tempo de diagnóstico e aumentar a confiança do médico no diagnóstico.

Clinical Guidance for Point-of-Care Ultrasound in the Emergency and Critical Care Areas after Implementing Insurance Coverage in Korea

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.

The sensitivity, specificity, and agreement of a point of care method: an assessment of the diagnostic accuracy / Sensibilidade, especificidade e concordância do método point of care: um estudo de precisão diagnóstica

Abstract The use of new technologies can improve screening in communities with difficult access to health. This article aims to evaluate the sensitivity, specificity, and agreement of a point of care test in comparison to laboratory methods for the determination of glucose (GLI), triglyceride (TG), and total cholesterol (TC) concentrations. This prospective study used data from the remaining adult population of quilombolas in Brazil. Laboratory tests using conventional methods for the analysis of venipuncture samples were used as a standard method to measure the concentrations of GLI (mg/dL), TG (mg/dL), and TC (mg/dL) and compared to the metered dose from the collection of fingertip capillary blood (point of care). Contingency tables (2x2) were used to estimate the sensitivity and specificity of the methods. Lin and Bland & Altman coefficients were used to statistically assess agreement, the level of significance was 5%. There was substantial agreement between the methods for measuring TG and poor agreement for of TC and GLI. Analysis of the Bland & Altman coefficients revealed that the fingertip method did not produce good measures. The point of care method did not offer a good ability to measure compared to that of the reference laboratory method.

Resumo O uso de novas tecnologias pode melhorar o screening em comunidades de difícil acesso à saúde. O objetivo deste artigo é avaliar a sensibilidade, especificidade e concordância do teste de point of care em comparação com método laboratorial para dosagem de Glicose (GLI), Triglicerídeo (TG) e Colesterol total (CT). Estudo prospectivo com dados de população de adultos remanescentes de quilombolas no Brasil. Exames laboratoriais convencionais para análise foram obtidos por venopunção, utilizados como método padrão para mensuração das concentrações de GLI (mg/dL), TG (mg/dL) e CT (mg/dL) e comparados a mensuração por meio de técnica de ponta de dedo (point of care). Tabelas de contingência (2x2) foram utilizadas para estimar sensibilidade e especificidade dos métodos e o coeficiente de Lin e análises de Bland & Altman foram métodos de concordância com nível de significância de 5%. Houve concordância substancial entre os métodos para mensuração de TG e fraca concordância para mensuração de CT e GLI. Os coeficientes de Bland & Altman indicam que o método de ponta de dedo não apresentou boa mensuração. O método point of care não apresentou boa capacidade de mensuração de Glicose, Triglicerídeo e Colesterol total tendo como referência o método laboratorial.

Should we wait for routine laboratory findings before intravenous thrombolysis for ischemic stroke? / 国际脑血管病杂志

Objective To investigate whether routine laboratory findings should be awaited before intravenous thrombolytic therapy for ischemic stroke.Methods Emergency patients (including ischemic and non-ischemic stroke cases) treated at the Department of Neurology,Beijing Tsinghua Changgung Hospital between January 1st 2016 and October 1st 2017 were analyzed retrospectively.The platelet count,prothrombin time (PT),activated partial thromboplastin time (APTT),and international normalized ratio (INR) in the first test were used as the main indicators.The proportion of patients with abnormalities between the overall population and the ischemic stroke subgroup was analyzed,and the above indicators between all patients with ischemic stroke and those receiving intravenous thrombolytic therapy were compared.The specific causes of failure to receive intravenous thrombolytic therapy in patients with ischemic stroke were analyzed descriptively.Results A total of 3 348 patients were enrolled.The emergency blood routine data were available in all patients.The emergency blood biochemical data were available in 3 278 patients (97.9％),and the emergency coagulation function data were available 1 742 patients (52.0％).There were no significant differences in the proportion of platelet count ＜ 100 × 109/L (1.3％ vs.1.5％;x2=0.29,P=0.586),APTT＞36.5s (3.8％ vs.3.6％;x2=0.06,P=0.809),PT ＞15s (2.6％ vs.2.8％;x2 =0.03,P=0.866),and INR ＞ 1.5 (2.0％ vs.2.0％;x2 =0.01,P=0.970) between the general population and the ischemic stroke subgroup.In a total of 687 patients with ischemic stroke,57 (8.3％) received intravenous thrombolysis.There were no significant difference in mean platelet count,APTT,PT,and INR between the thrombolytic group and the entire ischemic stroke group.Forty-nine patients (5.1％) with ischemic stroke had abnormal main indicators,of which 57.1％ (28/49) had a history of related diseases at the same time,while only 6.1％ (3/49) had abnormal laboratory indicators as the main factor of contraindication for intravenous thrombolysis.Conclusions Patients with acute ischemic stroke (especially in the absence of a history of related disease) have a low proportion of abnormal blood test findings and are less likely to be the main contributor of contraindication for intravenous thrombolysis.Therefore,when there is no reason to suspect that the test findings are abnormal,intravenous thrombolytic therapy should not be delayed because of waiting for the test findings.

Opportunities and challenges of point-of-care testing in clinical application / 中华检验医学杂志

Point-of-care testing is also called near-patient testing that is performed near or at the site of a patient with the result leading to possible change in the care of the patient.With the rapid development of sensor technology and new biomarkers,a great of diagnostic tests are transformed into POCT products and serve for doctors.This article will introduce the advantages and disadvantages of POCT in clinical application,compare core issues of POCT with different countries abroad in quality management,analyze the role of informatization of POCT and explore new clues of standardized POCT management.

Basic ultrasound training assessment in the initial abdominal trauma screening / Avaliação de treinamento básico em ultrassom na triagem inicial do trauma abdominal

ABSTRACT Objective: to verify the efficiency and usefulness of basic ultrasound training in trauma (FAST - Focused Assessment with Sonography in Trauma) for emergency physicians in the primary evaluation of abdominal trauma. Methods: a longitudinal and observational study was carried out from 2015 to 2017, with 11 emergency physicians from Hospital Universitário do Oeste do Paraná, submitted to ultrasound training in emergency and trauma (USET® - SBAIT). FAST results started to be collected two months after the course. These were compared with a composite score of complementary exams and surgical findings. Information was stored in a Microsoft Excel program database and submitted to statistical analysis. Results: FAST was performed in 120 patients. In the study, 38.4% of the assessed patients had a shock index ≥0.9. The composite score detected 40 patients with free peritoneal fluid, whereas FAST detected 27 cases. The method sensitivity was 67.5%, specificity was 98.7%, the positive predictive value was 96.4%, the negative predictive value was 85.39% and accuracy was 88%. All those with a positive FAST had a shock index ≥0.9. Fifteen patients with positive FAST and signs of instability were immediately submitted to surgery. Conclusions: the basic training of emergency physicians in FAST showed efficiency and usefulness in abdominal trauma assessment. Due to its low cost and easy implementation, this modality should be considered as a screening strategy for patients with abdominal trauma in health systems.

RESUMO Objetivo: verificar a eficiência e a utilidade do treinamento básico em ultrassom no trauma (Focused Assessment with Sonography in Trauma - FAST) para emergencistas, na avaliação primária do trauma abdominal. Métodos: estudo longitudinal, observacional, realizado durante o período de 2015 a 2017, com 11 emergencistas do Hospital Universitário do Oeste do Paraná, submetidos ao treinamento em ultrassom na emergência e trauma (USET® - SBAIT). Resultados dos FAST começaram ser coletados dois meses após o curso. Estes foram comparados com escore composto de exames complementares e achados cirúrgicos. Informações foram armazenadas em banco de dados do programa Microsoft Excel® e submetidas à análise estatística. Resultados: foram realizados FAST em 120 pacientes. No estudo, 38,4% dos pacientes avaliados apresentavam índice de choque ≥0,9. O escore composto detectou 40 pacientes com líquido livre peritoneal. FAST detectou 27 casos de líquido livre peritoneal. A sensibilidade do método foi de 67,5%, a especificidade de 98,7%, o valor preditivo positivo de 96,4%, o valor preditivo negativo de 85,39% e a acurácia foi de 88%. Todos que tiveram FAST positivo apresentavam índice de choque ≥0,9. Quinze pacientes com FAST positivo e sinais de instabilidade foram conduzidos imediatamente para cirurgia. Conclusões: o treinamento básico de emergencistas em FAST demonstrou eficiência e utilidade na avaliação do trauma abdominal. Por seu baixo custo e facilidade de implantação, esta modalidade deve ser considerada como estratégia de triagem de pacientes com trauma abdominal nos sistemas de saúde.

The influence of the decision making time by using point-of-care creatinine in patients with acute abdomen

OBJECTIVE: Radio-contrast abdomino-pelvic computed tomography (APCT) is considered the gold standard diagnostic tool for an acute abdomen in the emergency department. On the other hand, APCT has a risk of contrast-induced nephropathy. Emergency physicians evaluate the creatinine (Cr) level prior to taking a APCT for the above reason but it takes time to evaluation the serum Cr level. This study hypothesized that Cr measured by a point-of-care test (POCT) can shorten the time to making clinically important decisions for patients with an acute abdomen. METHODS: This prospective randomized study was conducted between March 2017 and October 2017. The subjects were divided into two groups (Cr measured by laboratory vs. Cr measured by POCT). To analyze the clinical acceptability for creatinine, agreement was demonstrated graphically by Bland-Altman plots. This study compared the time to make a clinically important decision by physicians and the length of stay at the emergency department in both groups. RESULTS: A total of 76 patients were eligible for the study, 38 patients were assigned to each group. There was no statistically significant difference in the time to the first medical examination (P=0.222) and emergency department stay time (P=0.802). On the other hand, the time to recognition of the Cr level (P < 0.001), time to performing APCT (P < 0.001), time to decision making (P < 0.001), and time to initiation of treatment (P < 0.001) were shortened significantly in the point-of-care creatinine group. CONCLUSION: In this study, the POCT for creatinine can allow rapid decision making by shortening the time to performing the radio-contrast APCT than the laboratory for patients with an acute abdomen.

Advanced diagnostic platforms reform the diagnosis of infections diseases / 中华检验医学杂志

The development of diagnostic techniques played an important role in the prevention and treatment of infectious diseases.The traditional diagnostic techniques , such as gram stain , microscopy , culture, antigen/antibody detection and polymerase chain reaction , were widely used in the clinical diagnosis.But they couldn′t meet the demands of clinic and infectious diseases surveillance.Therefore, the point of care testing and multiplex testing based on advanced diagnostic platforms were developing rapidly , which might have the potential to change infectious diseases diagnostics.

The use of the bedside examination to diagnose patients with acute dizziness and vertigo / 中国医师杂志

The causes of dizziness and vertigo were complex.The traditional diagnostic paradigm was based on symptom quality- what do you mean dizzy? According to this system,a patient with vertigo has a different list of possible causes than those who endorselightheadedness.The new diagnostic paradigm was based on their description of the timing,triggers of symptom strengthened the context of the vertigo medicine.More emergency physicians (EPs) lacked a significant knowledge regarding bedside examination and extensively convinced neuroimaging,resulting in misdiagnosis of serious causes such as stroke,unnecessary use of neuroimaging,and failure to institute specific treatment for many patients with inner ear causes of dizziness.This article focuses on how to use bedside physical examination to more accurately diagnose patients who present with acue dizziness,vertigo,or other similar vestiblar symptoms.This,in turn,could lead to lower rates of misdiagnosis,decrease utilization of expensive imaging studies,and increase in prompt,and correct treatments,thereby to improve patient outcomes.

Uso de ecografía en anestesia: Point of Care Ultrasound(POCUS) / Ultrasound in anesthesia: Point of Care Ultrasound (POCUS)

The ultrasound has become a very useful tool for the anesthesiologist because it complements and deepens the physical examination, ameliorating the clinical decision process. Among its many advantages are that is a bedside, abreviated exam, that avoids unnecesary transfers to other services, (of note in hemodinamically unstable Patients), besides is a radiation free method, repeatable as many times as needed. Its effectiveness for procedures is described, highlighting the central venous catheters and arterial lines placement. Also its diagnostic benefits, with accent on answering some specific questions. The full range of uses is described, incluiding: echocardiography, lung and pleura ultrasound, gastric ultrasound, extended FAST, airway, optic nerve sheath and the practical utility of each one.

El ultrasonido se ha convertido en una herramienta cada vez más útil para el anestesiólogo porque complementa y profundiza el examen físico, aportando información que facilita las decisiones clínicas. Sus principales ventajas son: ser un examen portátil que por lo tanto evita traslados innecesarios a otros servicios, lo que es importante en el caso de pacientes hemodinámicamente inestables, no invasivo, sin costos adicionales, libre de radiaciones, repetible las veces que sean necesarias y de rápida ejecución. Se describe su uso para procedimientos, en donde destaca el uso en instalación de catéteres venosos centrales y líneas arteriales, así como su uso con fines diagnósticos, en donde el énfasis es contestar preguntas específicas. Se describe en forma sucinta el uso de ecocardiografía, eco de pleura y pulmón, de estómago, FAST extendido, vía aérea, nervio óptico y la utilidad práctica de cada uno.

Performance Evaluation of Cartridge-Type Blood Gas Analyzer: i-Smart 300

BACKGROUND: Blood gas analysis plays a crucial role in critical care settings, and immediate and precise analysis improves clinical outcomes through prompt treatment. We evaluated the performance of a cartridge-type blood gas analyzer, i-Smart 300 (i-SENS, Korea), according to the Clinical and Laboratory Standard Institute (CLSI) guidelines and compared it to a conventional blood gas analyzer. METHODS: The precision was evaluated according to CLSI EP5-A3. The i-Smart 300 was compared to the Stat Profile Critical Care Xpress (STP CCX) (Nova CCX; Nova Biomedical, USA) according to CLSI EP9-A3 using the following eight parameters: pH, partial carbon dioxide pressure, partial oxygen pressure, sodium, potassium, chloride, ionized calcium, and hematocrit. Linearity was determined using five levels of control materials according to CLSI EP6-A. RESULTS: Within-run precision and total precision, demonstrated as coefficients of variation, ranged from 0.02 to 2.50% and from 0.05 to 3.46%, respectively. Correlation analysis yielded a correlation coefficient from 0.966 to 0.996 between the i-Smart 300 and the conventional analyzer (Nova CCX). The i-Smart 300 showed excellent linearity at eight parameters with acceptable percent recovery. CONCLUSIONS: The i-Smart 300, a portable cartridge-type blood gas analyzer, showed high precision and good correlation with a traditional bench-top blood gas analyzer. It could be useful in critical care settings.

The using status quo and analysis of POCT glucose meter / 中华检验医学杂志

Objective To investigate the problems during using, standard and quality management of the POCT glucose meters in hospital, to analyze the solutions, and to provide reference data for improving the test level of POCT in hospital.Methods The amount, brand and application of portable glucose meters in the hospital were obtained by 3 rounds of surveillance from May to July in 2013.All of those glucose meters were taken part in external quality assessment of Clinical Laboratory Center of National Health and Family Planning Commission.The test results of those glucose meters were compared with that of automatic biochemical analyzer, the comparison results were then analyzed.Results The POCT glucose meters possessed 5 brands in our hospital, and the amount and type of glucose meters in some clinical departments were often changed.When 4 brands which were detected as quality control samples by ministry of health, the accuracy of detection results of 3 concentration of brand Ⅲ were substandard, the CV% of two levels were 11.9%and 10.1%respectively, the remaining 3 brands were in line with the requirements.The qualified percentages of 3 times of comparison were 85.0%, 92.0%and 97.4%.Conclusions The hospital should select the brand of portable glucose meters reasonably, correct use of glucose meters, and it is very necessary to build indoor and interstitial quality evaluation system, at the same time, suggesting the hospital to establish the POCT quality management team, to carry out the instrument comparison periodically, so to guarantee the accurate, reliable results of POCT in hospital.

Method for the modeling and structuring of computerized Nursing in intensive care / Metodología para el modelado y estructura del proceso de Enfermería computarizado en cuidados intensivos / Metodologia para modelagem e estruturação do processo de Enfermagem informatizado em terapia intensiva

ABSTRACT Hybrid study of technological production and methodological research aimed at restructuring and organize data and information from the Computerized Nursing Process, based on the International Classification for Nursing Practice (ICNP(r)) version 2.0 for Intensive Care Units. Study carried out in four stages: review of conceptual modeling and system logic; grouping of clinical situations in order of increasing complexity; determination of diagnoses and interventions for each clinical situation and; selection and registration of diagnoses and nursing interventions in the computerized system. As a result, 1,349 possibilities for clinical evaluations, 949 diagnoses and 438 nursing interventions were organized, restructured and divided into nine human body systems. The Computerized Nursing Process based on ICNP(r) can measure results, is adaptable to any reality and allows nurses to use this tool as a structured knowledge base.

RESUMEN Estudio híbrido de producción tecnológica e investigación metodológica que tuvo por objetivo reestructurar y organizar los datos e información del Proceso de Enfermería Computarizada de la Clasificación Internacional para la Práctica de Enfermería (CIPE(r)) Versión 2.0 en unidades de cuidados intensivos. Estudio realizado en cuatro etapas: revisión de modelado conceptual y lógica del sistema; agrupación de situaciones clínicas en orden de complejidad creciente; determinar los diagnósticos e intervenciones para cada situación clínica y; selección y registro de diagnósticos e intervenciones de enfermería en el sistema informatizado. Se obtuvo como resultado la organización de 1.349 posibilidades para las evaluaciones clínicas, 949 diagnósticos y 438 intervenciones de enfermería, reestructurados y distribuidas en nueve sistemas del cuerpo humano. El Proceso de Enfermería Informatizado basado en CIPE(r) puede medir los resultados, es adaptable a cualquier realidad y permite a las enfermeras a utilizar esta herramienta como base estructura de su conocimiento.

RESUMO Estudo híbrido de produção tecnológica e pesquisa metodológica que objetivou reestruturar e organizar os dados e informações do Processo de Enfermagem Informatizado, a partir da Classificação Internacional para as Práticas de Enfermagem (CIPE(r)) versão 2.0 para Unidades de Terapia Intensiva. Estudo desenvolvido em quatro etapas: revisão da modelagem conceitual e lógica do sistema; agrupamento de situações clínicas por ordem de complexidade crescente; determinação de diagnósticos e intervenções para cada situação clínica; e seleção e cadastro dos diagnósticos e intervenções de enfermagem no sistema informatizado. Obteve-se, como resultado, a organização de 1.349 possibilidades de avaliações clínicas, 949 diagnósticos e 438 intervenções de enfermagem, reestruturadas e distribuídas em nove sistemas do corpo humano. O Processo de Enfermagem Informatizado baseado na CIPEÒ pode mensurar resultados, é adaptável a qualquer realidade e permite ao enfermeiro utilizar esta ferramenta como base estruturada de conhecimento.

Evaluation of the i-STAT Point-of-Care Analyser

BACKGROUND: Point-of-care testing (POCT) is designed to be used near the site where the clinical care is being delivered. The demand for POCT in the medical field is expanding significantly, given that rapid results can eventually lead to early diagnosis and immediate clinical management of diseases. Therefore, the aim of this study was to evaluate the performance of the i-STAT POC analyser (Abbott Diagnostics, USA) for testing 8 chemical analytes (viz., sodium, potassium, chloride, total carbon dioxide, blood urea nitrogen, creatinine, glucose, and ionised calcium) and 2 hematological analytes (hematocrit [HCT], hemoglobin [Hb]). METHODS: The precision and linearity of the 10 analytes were measured according to Clinical and Laboratory Standards Institute (CLSI) EP15-A3 and EP6-A guidelines. Comparisons with a central laboratory hematology analyser, Coulter LH 780 (Beckman Coulter Inc., USA), and a chemical analyser, UniCel DxC 880i (Beckman Coulter Inc.), were performed using 85 patient samples according to CLSI EP9-A3. RESULTS: The coefficient of variation values for the within-run precision and total precision at 3 levels of all analytes were within 5%, except those for low level creatinine. In the aspect of linearity, the correlation coefficient values of all analytes were over 0.975 in the clinically important concentration range. A very high correlation was observed in glucose, blood urea nitrogen and creatinine (R>0.975), high correlation was observed in sodium, potassium, Hct and Hb (R>0.9), and relatively good correlation was observed in chloride and total carbon dioxide (R>0.7) compared to the central laboratory analysers. CONCLUSIONS: i-STAT showed relatively high precision and linearity, and comparable data to that of routine hematology and chemistry analysers. This device was concluded to have potential for providing faster results and relatively acceptable values to clinicians in need of immediate results.